Health education for microcredit clients in Peru: a randomized controlled trial potx

R E S EARCH AR TIC L E Open Access

Health education for microcredit clients in Peru:

a randomized controlled trial

Rita Hamad1*, Lia CH Fernald2

, Dean S Karlan3

Abstract

Background: Poverty, lack of female empowerment, and lack of education are major risk factors for childhood

illness worldwide. Microcredit programs, by offering small loans to poor individuals, attempt to address the first

two of these risk factors, poverty and gender disparity. They provide clients, usually women, with a means to invest

in their businesses and support their families. This study investigates the health effects of also addressing the

remaining risk factor, lack of knowledge about important health issues, through randomization of members of a

microcredit organization to receive a health education module based on the World Health Organization’s

Integrated Management of Childhood Illness (IMCI) community intervention.

Methods: Baseline data were collected in February 2007 from clients of a microcredit organization in Pucallpa,

Peru (n = 1,855) and their children (n = 598). Loan groups, consisting of 15 to 20 clients, were then randomly

assigned to receive a health education intervention involving eight monthly 30-minute sessions given by the

organization’s loan officers at monthly loan group meetings. In February 2008, follow-up data were collected, and

included assessments of sociodemographic information, knowledge of child health issues, and child health status

(including child height, weight, and blood hemoglobin levels). To explore the effects of treatment (i.e., participation

in the health education sessions) on the key outcome variables, multivariate regressions were implemented using

ordinary least squares.

Results: Individuals in the IMCI treatment arm demonstrated more knowledge about a variety of issues related to

child health, but there were no changes in anthropometric measures or reported child health status.

Conclusions: Microcredit clients randomized to an IMCI educational intervention showed greater knowledge about

child health, but no differences in child health outcomes compared to controls. These results imply that the

intervention did not have sufficient intensity to change behavior, or that microcredit organizations may not be an

appropriate setting for the administration of child health educational interventions of this type.

Trial Registration: This study is registered with ClinicalTrials.gov, NCT01047033.

Background

A Comprehensive Intervention to Reduce Childhood

Illness

Since 1995, the Division of Child Health and Develop￾ment at the World Health Organization has been part￾nering with governments and non-governmental

organizations to promote a comprehensive strategy to

address the multi-factorial and interactive determinants

of childhood illness [1]. Known as the Integrated Man￾agement of Childhood Illness (IMCI), this program’s

goal is to reduce death, illness, and disability among

children less than five years old, while supporting their

growth and development [2]. The three goals of IMCI

are to improve a country’s infrastructure, to train health

workers, and to deliver community-based interventions

such as health education. The issues addressed by the

three components of IMCI are modified based on the

needs of the region of delivery, but generally include

breastfeeding promotion, and the prevention and treat￾ment of pneumonia, diarrhea, malaria, measles, and mal￾nutrition through various techniques [1].

Studies in many developing countries have shown

IMCI to be successful at improving child health out￾comes. Some have assessed interventions encompassing

* Correspondence: [email protected]

1

Joint Medical Program, University of California Berkeley - University of

California San Francisco, Berkeley, USA

Full list of author information is available at the end of the article

Hamad et al. BMC Public Health 2011, 11:51

http://www.biomedcentral.com/1471-2458/11/51

© 2011 Hamad et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons

Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in

any medium, provided the original work is properly cited.